Durable long-term remission with chemotherapy alone for stage II to IV laryngeal cancer

Fadlo R. Khuri, F. Christopher Holsinger, Merrill S. Kies, Eduardo M. Diaz, Ann M. Gillenwater, Jan S. Lewin, Lawrence E. Ginsberg, Bonnie S. Glisson, Adam S. Garden, Nebil Ark, Heather Y. Lin, J. Jack Lee, Adel K. El-Naggar, Waun Ki Hong, Dong M. Shin

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Abstract

Purpose For patients with stage II to IV laryngeal cancer, radiation therapy (RT) either alone or with concurrent chemotherapy provides the highest rate of organ preservation but can be associated with functional impairment. Thus, we studied the use of induction chemotherapy with or without conservation laryngeal surgery (CLS). Our objectives were to study the sensitivity of laryngeal cancer to platinum-based chemotherapy alone and to highlight the efficacy of CLS in this setting. Patients and Methods Thirty-one previously untreated patients with laryngeal cancer (T2-4, N0-1, M0), who were resectable with CLS, were enrolled. Patients received three to four cycles of paclitaxel, ifosfamide, and cisplatin (TIP) chemotherapy, and response was assessed histologically. Patients with partial response (PR) proceeded to CLS. Patients achieving pathologic complete response (pCR) received an additional three cycles of TIP and no other treatment. Results Thirty patients were assessable for response. With TIP chemotherapy alone, 11 patients (37%) achieved pCR, 10 of whom (33%) remain alive with durable disease remission and no evidence of recurrence over a median follow-up time of 5 years. Nineteen patients (63%) treated with TIP alone achieved PR. The overall laryngeal preservation (LP) rate was 83%, and only five patients (16%) required postoperative RT. No patient required a gastrostomy tube or tracheotomy. Conclusion Chemotherapy alone in selected patients with T2-4, N0-1 laryngeal cancer can provide durable disease remission at 5 years. For patients with PR, CLS provides a high rate of LP. This prospective study suggests that chemotherapy alone may cure selected patients with laryngeal cancer, warranting further prospective investigation.

Original languageEnglish (US)
Pages (from-to)1976-1982
Number of pages7
JournalJournal of Clinical Oncology
Volume27
Issue number12
DOIs
StatePublished - Apr 20 2009

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Laryngeal Neoplasms
Drug Therapy
Radiotherapy
Organ Preservation
Tracheotomy
Ifosfamide
Induction Chemotherapy
Gastrostomy
Platinum

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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Durable long-term remission with chemotherapy alone for stage II to IV laryngeal cancer. / Khuri, Fadlo R.; Holsinger, F. Christopher; Kies, Merrill S.; Diaz, Eduardo M.; Gillenwater, Ann M.; Lewin, Jan S.; Ginsberg, Lawrence E.; Glisson, Bonnie S.; Garden, Adam S.; Ark, Nebil; Lin, Heather Y.; Lee, J. Jack; El-Naggar, Adel K.; Hong, Waun Ki; Shin, Dong M.

In: Journal of Clinical Oncology, Vol. 27, No. 12, 20.04.2009, p. 1976-1982.

Research output: Contribution to journalArticle

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title = "Durable long-term remission with chemotherapy alone for stage II to IV laryngeal cancer",
abstract = "Purpose For patients with stage II to IV laryngeal cancer, radiation therapy (RT) either alone or with concurrent chemotherapy provides the highest rate of organ preservation but can be associated with functional impairment. Thus, we studied the use of induction chemotherapy with or without conservation laryngeal surgery (CLS). Our objectives were to study the sensitivity of laryngeal cancer to platinum-based chemotherapy alone and to highlight the efficacy of CLS in this setting. Patients and Methods Thirty-one previously untreated patients with laryngeal cancer (T2-4, N0-1, M0), who were resectable with CLS, were enrolled. Patients received three to four cycles of paclitaxel, ifosfamide, and cisplatin (TIP) chemotherapy, and response was assessed histologically. Patients with partial response (PR) proceeded to CLS. Patients achieving pathologic complete response (pCR) received an additional three cycles of TIP and no other treatment. Results Thirty patients were assessable for response. With TIP chemotherapy alone, 11 patients (37{\%}) achieved pCR, 10 of whom (33{\%}) remain alive with durable disease remission and no evidence of recurrence over a median follow-up time of 5 years. Nineteen patients (63{\%}) treated with TIP alone achieved PR. The overall laryngeal preservation (LP) rate was 83{\%}, and only five patients (16{\%}) required postoperative RT. No patient required a gastrostomy tube or tracheotomy. Conclusion Chemotherapy alone in selected patients with T2-4, N0-1 laryngeal cancer can provide durable disease remission at 5 years. For patients with PR, CLS provides a high rate of LP. This prospective study suggests that chemotherapy alone may cure selected patients with laryngeal cancer, warranting further prospective investigation.",
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T1 - Durable long-term remission with chemotherapy alone for stage II to IV laryngeal cancer

AU - Khuri, Fadlo R.

AU - Holsinger, F. Christopher

AU - Kies, Merrill S.

AU - Diaz, Eduardo M.

AU - Gillenwater, Ann M.

AU - Lewin, Jan S.

AU - Ginsberg, Lawrence E.

AU - Glisson, Bonnie S.

AU - Garden, Adam S.

AU - Ark, Nebil

AU - Lin, Heather Y.

AU - Lee, J. Jack

AU - El-Naggar, Adel K.

AU - Hong, Waun Ki

AU - Shin, Dong M.

PY - 2009/4/20

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N2 - Purpose For patients with stage II to IV laryngeal cancer, radiation therapy (RT) either alone or with concurrent chemotherapy provides the highest rate of organ preservation but can be associated with functional impairment. Thus, we studied the use of induction chemotherapy with or without conservation laryngeal surgery (CLS). Our objectives were to study the sensitivity of laryngeal cancer to platinum-based chemotherapy alone and to highlight the efficacy of CLS in this setting. Patients and Methods Thirty-one previously untreated patients with laryngeal cancer (T2-4, N0-1, M0), who were resectable with CLS, were enrolled. Patients received three to four cycles of paclitaxel, ifosfamide, and cisplatin (TIP) chemotherapy, and response was assessed histologically. Patients with partial response (PR) proceeded to CLS. Patients achieving pathologic complete response (pCR) received an additional three cycles of TIP and no other treatment. Results Thirty patients were assessable for response. With TIP chemotherapy alone, 11 patients (37%) achieved pCR, 10 of whom (33%) remain alive with durable disease remission and no evidence of recurrence over a median follow-up time of 5 years. Nineteen patients (63%) treated with TIP alone achieved PR. The overall laryngeal preservation (LP) rate was 83%, and only five patients (16%) required postoperative RT. No patient required a gastrostomy tube or tracheotomy. Conclusion Chemotherapy alone in selected patients with T2-4, N0-1 laryngeal cancer can provide durable disease remission at 5 years. For patients with PR, CLS provides a high rate of LP. This prospective study suggests that chemotherapy alone may cure selected patients with laryngeal cancer, warranting further prospective investigation.

AB - Purpose For patients with stage II to IV laryngeal cancer, radiation therapy (RT) either alone or with concurrent chemotherapy provides the highest rate of organ preservation but can be associated with functional impairment. Thus, we studied the use of induction chemotherapy with or without conservation laryngeal surgery (CLS). Our objectives were to study the sensitivity of laryngeal cancer to platinum-based chemotherapy alone and to highlight the efficacy of CLS in this setting. Patients and Methods Thirty-one previously untreated patients with laryngeal cancer (T2-4, N0-1, M0), who were resectable with CLS, were enrolled. Patients received three to four cycles of paclitaxel, ifosfamide, and cisplatin (TIP) chemotherapy, and response was assessed histologically. Patients with partial response (PR) proceeded to CLS. Patients achieving pathologic complete response (pCR) received an additional three cycles of TIP and no other treatment. Results Thirty patients were assessable for response. With TIP chemotherapy alone, 11 patients (37%) achieved pCR, 10 of whom (33%) remain alive with durable disease remission and no evidence of recurrence over a median follow-up time of 5 years. Nineteen patients (63%) treated with TIP alone achieved PR. The overall laryngeal preservation (LP) rate was 83%, and only five patients (16%) required postoperative RT. No patient required a gastrostomy tube or tracheotomy. Conclusion Chemotherapy alone in selected patients with T2-4, N0-1 laryngeal cancer can provide durable disease remission at 5 years. For patients with PR, CLS provides a high rate of LP. This prospective study suggests that chemotherapy alone may cure selected patients with laryngeal cancer, warranting further prospective investigation.

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